A patient of severe psoriasis for 15 years is taking methotrexate. Now he developed abnormal LFT and jaundice. He should be managed with: (AIIMS May 2014)
|A||Stop methotrexate and start dapsone|
|B||Stop methotrexate and start steroid|
|C||Continue methotrexate and start cyclosporine|
|D||Stop methotrexate and start cyclosporine|
Stop methotrexate and start cyclosporine
1). Methotrexate is an antimetabolite because it is competitive antagonist of tetrahydrofolate reductase, blocking the formation of thymidine and thus DNA. It is highly effective treatment for patients with severe psoriasis. Important side effects are bone marrow suppression and hepatotoxicity
2). Cyclosporine is an immunosuppressant used in organ transplantation. It is dramatically effective in psoriasis in a dose of 3-5 mg/kg/day. Toxic side effects include severe renal damage and hypertension.
3). Total cumulative dose is 2.5 gms.